Body piercing provides a unique route of metal exposure.
Objective
The aim of this study was to update previous analyses using the North American Contact Dermatitis Group data comparing pierced and unpierced individuals.
Methods
This was a retrospective cross-sectional analysis of 17,912 patients patch tested by the North American Contact Dermatitis Group from 2007 to 2014 for demographics, positive reactions to metals (nickel, cobalt, chromium), and detailed analysis of nickel reactions by age, sex, and source of exposure.
Results
Piercing was significantly associated with female sex, being older than 18 years, and atopy (P < 0.003). Nickel sensitivity was associated with 1 or more piercing for men and women combined (P < 0.0001; relative risk [RR], 2.54; 95% confidence interval [CI], 2.35–2.75), although this association was stronger for men (RR, 2.21; 95% CI, 1.77–2.76) than women (RR, 1.47; 95% CI, 1.31–1.65). The frequency of positivity to nickel increased with number of piercings (14.3% for 1 piercing to 34.0% with ≥5 piercings). Piercing was not significantly associated with cobalt sensitivity alone (P = 0.8992) and was negatively associated with chromium sensitivity (P < 0.0001). Jewelry was the most common source of allergic reactions to nickel irrespective of sex or pierced status.
Conclusions
Nickel sensitivity was significantly associated with piercing in both men and women. Jewelry was the most common source.
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References
1.
GaulJE. Development of allergic nickel dermatitis from earrings. JAMA, 1967; 200:176–178.
2.
PrystowskySD, AllenAM, SmithRW, et al.Allergic contact hypersensitivity to nickel, neomycin, ethylenediamine, and benzocaine. Relationships between age, sex, history of exposure, and reactivity to standard patch tests and use tests in a general population. Arch Dermatol, 1979; 115:959–962.
Larsson-StymneB, WidströmL. Ear piercing—a cause of nickel allergy in schoolgirls?. Contact Dermatitis, 1985; 13:289–293.
5.
Van HoogstratenIM, AndersenKE, von BlombergBM, et al.Reduced frequency of nickel allergy upon oral nickel contact at an early age. Clin Exp Immunol, 1991; 85:441–445.
6.
McDonaghAJ, WrightAL, CorkMJ, et al.Nickel sensitivity: the influence of ear piercing and atopy. Br J Dermatol, 1992; 126:16–18.
7.
NielsenNH, MennéT. Nickel sensitization and ear piercing in an unselected Danish population. Glostrup Allergy Study. Contact Dermatitis, 1993; 29:16–21.
8.
DotterudLK, FalkES. Metal allergy in north Norwegian schoolchildren and its relationship with ear piercing and atopy. Contact Dermatitis, 1994; 31:308–313.
9.
MeijerC, BredbergM, FischerT, et al.Ear piercing, and nickel and cobalt sensitization, in 520 young Swedish men doing compulsory military service. Contact Dermatitis, 1995; 32:147–149.
10.
KerosuoH, KullaaA, KerosuoE, et al.Nickel allergy in adolescents in relation to orthodontic treatment and piercing of ears. Am J Orthod Dentofacial Orthop, 1996; 109:148–154.
11.
NakadaT, IijimaM, NakayamaH, et al.Role of ear piercing in metal allergic contact dermatitis. Contact Dermatitis, 1997; 36:233–236.
12.
Smith-SivertsenT, DotterudLK, LundE. Nickel allergy and its relationship with local nickel pollution, ear piercing, and atopic dermatitis: a population-based study from Norway. J Am Acad Dermatol, 1999; 40:726–735.
13.
MattilaL, KilpelainenM, TerhoEO, et al.Prevalence of nickel allergy among Finnish university students in 1995. Contact Dermatitis, 2001; 44:218–223.
14.
JensenCS, LisbyS, BaadsgaardO, et al.Decrease in nickel sensitization in a Danish schoolgirl population with ears pierced after implementation of a nickel-exposure regulation. Br J Dermatol, 2002; 146:636–642.
15.
MortzCG, LauritsenJM, Bindslev-JensenC, et al.Nickel sensitization in adolescents and association with ear piercing, use of dental braces and hand eczema. The Odense Adolescence Cohort Study on Atopic Diseases and Dermatitis (TOACS). Acta Derm Venereol, 2002; 82:359–364.
16.
BrandaoMH, GontijoB, GirundiMA, et al.Ear piercing as a risk factor for contact allergy to nickel. J Pediatr (Rio J), 2010; 86:149–154.
17.
ThyssenJP. Nickel and cobalt allergy before and after nickel regulation—evaluation of a public health intervention. Contact Dermatitis, 2011; 65(suppl 1):1–68.
18.
ForsR, PerssonM, BergstromE, et al.Lifestyle and nickel allergy in a Swedish adolescent population: effects of piercing, tattooing and orthodontic appliances. Acta Derm Venereol, 2012; 92:664–668.
19.
WarshawEM, Kingsley-LosoJL, DeKovenJG, et al.Body piercing and metal allergic contact sensitivity: North American Contact Dermatitis Group data from 2007 to 2010. Dermatitis, 2014; 25:255–264.
20.
DeKovenJG, WarshawEM, BelsitoDV, et al.North American Contact Dermatitis Group patch test results 2013–2014. Dermatitis, 2017; 28:33–46.
21.
WarshawEM, MaibachHI, TaylorJS, et al.North American Contact Dermatitis Group patch test results: 2011–2012. Dermatitis, 2015; 26:49–59.
22.
WarshawEM, BelsitoDV, TaylorJS, et al.North American Contact Dermatitis Group patch test results: 2009 to 2010. Dermatitis, 2013; 24:50–59.
23.
FranswayAF, ZugKA, BelsitoDV, et al.North American Contact Dermatitis Group patch test results for 2007–2008. Dermatitis, 2013; 24:10–21.
24.
ZugKA, WarshawEM, FowlerJFJr, et al.Patch-test results of the North American Contact Dermatitis Group 2005–2006. Dermatitis, 2009; 20:149–160.
25.
SchnuchA, GeierJ, UterW, et al.National rates and regional differences in sensitization to allergens of the standard series. Population-adjusted frequencies of sensitization (PAFS) in 40,000 patients from a multicenter study (IVDK). Contact Dermatitis, 1997; 37:200–209.
26.
HamannD, ThyssenJP, HamannCR, et al.Jewellery: alloy composition and release of nickel, cobalt and lead assessed with the EU synthetic sweat method. Contact Dermatitis, 2015; 73:231–238.
27.
UterW, SchmidM, SchmidtO, et al.Cobalt release from earrings and piercing jewellery—analytical results of a German survey. Contact Dermatitis, 2014; 70:369–375.
28.
HamannC, HamannD, HamannKK, et al.Cobalt release from inexpensive earrings from Thailand and China. Contact Dermatitis, 2011; 64:238–240.
29.
BregnbakD, JohansenJD, HamannD, et al.Assessment of chromium(VI) release from 848 jewellery items by use of a diphenylcarbazide spot test. Contact Dermatitis, 2016; 75:115–117.
30.
EhrlichA, KucenicM, BelsitoDV. Role of body piercing in the induction of metal allergies. Am J Contact Dermat, 2001; 12:151–155.
31.
ThyssenJP, SkareL, LundgrenL, et al.Sensitivity and specificity of the nickel spot (dimethylglyoxime) test. Contact Dermatitis, 2010; 62:279–288.
32.
BoonchaiW, ManeeprasopchokeP, SuiwongsaB, et al.Assessment of nickel and cobalt release from jewelry from a non-nickel directive country. Dermatitis, 2015; 26:44–48.
33.
IngberA, KleinS, DavidM. The nickel released from jewelry in Israel and its clinical relevance. Contact Dermatitis, 1998; 39:195–197.
34.
CheongSH, ChoiYW, ChoiHY, et al.Nickel and cobalt release from jewellery and metal clothing items in Korea. Contact Dermatitis, 2014; 70:11–18.
35.
MortzCG, Bindslev-JensenC, AndersenKE. Nickel allergy from adolescence to adulthood in the TOACS cohort. Contact Dermatitis, 2013; 68:348–356.
36.
HamannD, HamannC, LiLF, et al.The Sino-American belt study: nickel and cobalt exposure, epidemiology, and clinical considerations. Dermatitis, 2012; 23:117–123.
